Overcoming Logistical Delays and Resource Constraints: Achieving Complete Response in High-Risk Medulloblastoma with Delayed Metastatic Progression at a Newly Established Secondary Cancer Center
Mymoona Alzouebi, MD1*, Ismail Al Dahlawi, PhD2, Majed Alawiat, RT(T)3, Batool Alghadeer, MD4, Ahmed Albaqshi, MD5, Asmaa Elgayer, MD6, Salma Almohammed, MD7
1Consultant Radiation Oncologist, Head of Radiation Oncology, Aljaber Cancer Centre, King Fahad Hospital, Alahsa, KSA
2Consultant Medical Physicist, Department of Radiation Oncology, King Fahad Specialist Hospital-Dammam, Dammam, KSA
3Senior Radiation Therapist, Aljaber Cancer Centre, King Fahad Hospital, Alahsa, KSA
4Consultant Paediatric Haematology and Transplant Oncologist, King Fahad Hospital, Alahsa, KSA
5Consultant Diagnostic and Interventional Neuroradiology, King Fahad Hospital, Alahsa, KSA
6Paediatric Oncology Registrar, King Fahad Hospital, Alahsa, KSA 7Consultant Paediatric Haematology and Transplant Oncologist, King Fahad Hospital, Alahsa, KSA
*Corresponding Author: Dr. Mymoona Alzouebi, MD, Consultant Radiation Oncologist, Head of Radiation Oncology, Aljaber Cancer Centre, King Fahad Hospital, Alahsa, Kingdom of Saudi Arabia.
DOI: https://doi.org/10.58624/SVOAMR.2026.04.020
Received: July 08, 2026
Published: September 01, 2026
Citation: Alzouebi M, Al Dahlawi I, Alawiat M, Alghadeer B, Albaqshi A, Elgayer A, Almohammed S. Overcoming Logistical Delays and Resource Constraints: Achieving Complete Response in High-Risk Medulloblastoma with Delayed Metastatic Progression at a Newly Established Secondary Cancer Center. SVOA Medical Research 2026, 4:5, 173-183. doi: 10.58624/SVOAMR.2026.04.020
Abstract
Introduction: High-risk Medulloblastoma (MB) requires time-critical, multimodal therapy. This report details the management of a high-risk MB case where critical logistical barriers necessitated treatment adaptation in a newly established, resource-limited secondary center.
Case Presentation: A 12-year-old female with Anaplastic/Large Cell MB suffered a critical two-month delay in initiating adjuvant therapy due to referral failures. This delay resulted in disease progression and confirmed M+ spinal drop metastases. The patient underwent second surgery, followed by intensive therapy.
Intervention and Adaptation: Initial resource deficits (radiotherapy immobilization equipment and skilled radiation therapists) were overcome through rapid inter-institutional collaboration. Due to institutional inpatient bed restrictions, a modified outpatient chemotherapy protocol (Carboplatin, Etoposide, Cyclophosphamide, Vincristine) was successfully delivered. While the patient experienced significant hematologic toxicity (requiring transfusions and multiple hospitalizations for febrile neutropenia), the regimen was completed without life-threatening infections.
Conclusion: The patient achieved a Radiological Complete Response (CR) at all sites and demonstrated remarkable functional recovery (independent mobility, improved speech). This case validates the feasibility of safely delivering high-quality, intensive pediatric neuro-oncology protocols in a resource-limited setting through thoughtful protocol adaptation and robust multi-institutional collaboration.
Keywords: Medulloblastoma, Pediatric Neuro-Oncology, Resource-Limited Settings, Multidisciplinary Collaboration